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Pars plana vitrectomy in the pediatric population: indications and long-term results
1Department of Ophthalmology, General Faculty Hospital, 1st Medical Faculty, Charles University, Prague, Czech Republic.
Insights
Pars plana vitrectomy (PPV) in children shows comparable results to adults, with injuries being the most common reason for the procedure. Timely silicone oil removal is crucial for long-term visual function in pediatric patients.
Area of Science:
- Ophthalmology
- Surgical Innovation
- Pediatric Eye Care
Background:
- Pars plana vitrectomy (PPV) is a key surgical intervention for various retinal conditions.
- Understanding its efficacy and indications in pediatric populations is essential for optimizing outcomes.
- Long-term data on pediatric PPV, especially concerning complex retinal detachments, is valuable.
Purpose of the Study:
- To determine the primary indications for pars plana vitrectomy (PPV) in children.
- To evaluate the long-term anatomical and functional results of PPV in the pediatric population.
- To assess the role of silicone oil implantation (SOI) and its subsequent removal in pediatric retinal surgery.
Main Methods:
- A retrospective analysis of 60 eyes from 57 pediatric patients (aged 6-15 years) who underwent PPV.
- Categorization of indications included complicated retinal detachment (RD) with proliferative vitreoretinopathy (PVR), giant tear (GT) RD, intraocular foreign body (IOFB), and vitreous hemorrhage/exudation.
- Silicone oil implantation (SOI) was utilized in 65% of cases, with follow-up ranging from 6 to 72 months (mean 42 months).
Main Results:
- Anatomical success (flat macula) was achieved in 77% of eyes, and functional success (visual acuity ≥0.02) in 72%.
- Outcomes were most favorable for IOFB and traction RD post-penetrating injury (100% and 91% success).
- Silicone oil was removed in 63% of implanted eyes, with the retina remaining attached in 85% of those cases.
Conclusions:
- The indications and long-term outcomes of pediatric PPV are comparable to those in adult patients.
- Ocular injuries and their complications represent the most frequent indications for PPV in children.
- A strategy involving primary silicone oil implantation and subsequent removal is effective for complex retinal detachments in pediatric eyes, emphasizing the importance of timely removal for visual function preservation.
Purpose:
To establish the indications and the long-term results of pars plana vitrectomy (PPV) in the pediatric population.
Methods:
PPV was performed in 60 eyes of 57 children, 45 boys and 12 girls, aged from 6 to 15 years. Twenty-nine eyes (48%) suffered from complicated rhegmatogenous or traction retinal detachment (RD) with advanced proliferative vitreoretinopathy (PVR), 19 eyes (32%) had RD due to an idiopathic or traumatic giant tear (GT), 7 eyes (11%) had an intraocular foreign body (IOFB), and 5 eyes (9%) had hemorrhage or exudation into the vitreous. In 43 eyes (65%) silicone oil implantation (SOI) was indicated, in 39 eyes (91%) a primary SOI, and in 4 eyes (9%) a secondary SOI. The patients were followed up for 6-72 months, mean 42 months.
Results:
At the end of follow-up, anatomical success with a flat macula was achieved in 77% of the eyes, and functional success with visual acuity of 0.02 and better in 72%. The results were best in IOFB and traction RD after penetrating injury (success in 100% and 91%); the worst results were in RD after regressed retinopathy of prematurity and RD due to idiopathic GT (success in 50% and 54%). After SOI silicone oil was removed in 27 out of 43 eyes (63%), and the retina remained attached in 23 of these eyes (85%).
Conclusions:
Indications and the long-term results of PPV in children were comparable with those in the adult. By far the most frequent indications were injuries and their complications. In complicated RD, a radical approach with primary SOI and later silicone oil removal proved useful. In children, with their long life expectancy, timely removal of silicone oil is vital for maintaining the function of the eye.